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CPT code 31295: Sinus dilation, maxillary sinus ostium2026 Medicare rate & RVUs in Rhode Island

Endoscopic balloon dilation of a maxillary sinus ostium is reported when an ENT surgeon enlarges its natural drainage opening without conventional tissue removal.

CMS RVU26DEffective Oct 1, 2026One payment locality14.5K Medicare services in 2024

In Rhode Island, Medicare pays $1,626.52 for 31295 in the office and $136.33 when it’s performed in a hospital or facility.

$1,626.52Office (non-facility)
$136.33Hospital or facility
+3.1%vs the national office rate ($1,577.52)

Check a contract rate as a % of Medicare · 31295 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 31295 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Rhode Island
  2. What 31295 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 31295 covers

An otolaryngologist uses a nasal endoscope to guide a balloon into the natural opening of a maxillary sinus and enlarge that drainage pathway. This approach may be used for obstructed maxillary sinus drainage, including in patients with chronic or recurrent sinusitis. The procedure is distinct from creating a wider opening by removing tissue or bone during conventional endoscopic sinus surgery.

Report the code for the maxillary sinus ostium dilation performed, and document the treated side, the sinus, the technique, and the clinical findings supporting the intervention. CMS treats the service as a minor procedure with a 0-day global period, so same-day preoperative and postoperative care is included. For bilateral treatment, modifier 50 is paid at 150%. When related endoscopies are performed together, endoscopy family pricing applies. CMS allows payment for an assistant at surgery; co-surgeons and team surgery are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How Rhode Island compares for 31295

Across 109 of 109 payment localities, the office rate for 31295 runs from $1,363.00 in Arkansas to $2,233.82 in San Benito County, CA. Rhode Island pays $1,626.52. The RVUs are the same everywhere; the geographic indexes change the dollars.

31295 in Rhode Island vs other payment areas
  1. Rhode Island · this page$1,626.52
  2. Los Angeles, CA · California$1,846.98+$220.46
  3. Washington, DC area · District of Columbia$1,846.58+$220.06
  4. Miami, FL · Florida$1,657.98+$31.46
  5. Chicago, IL · Illinois$1,602.39−$24.13
  6. Manhattan, NY · New York$1,830.00+$203.48
  7. Alaska · Alaska$1,711.58+$85.06

Other areas in Rhode Island first, then benchmark localities. Bars start at $0.

Every other payment area

31295 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$1,387.29$125.03
ArkansasArkansas$1,363.00$123.82
ArizonaArizona$1,529.87$132.01
Bakersfield, CACalifornia$1,715.86$134.79
Chico, CACalifornia$1,714.73$133.66
El Centro, CACalifornia$1,714.80$133.72
Fresno, CACalifornia$1,714.73$133.66
Hanford, CACalifornia$1,714.73$133.66

31295 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$1,363.00

$1,974.28

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
31295 office rate range by state
State / territoryOffice rate rangeLocalities
AK$1,711.581
AL$1,387.291
AR$1,363.001
AZ$1,529.871
CA$1,714.73–$2,233.8229
CO$1,670.231
CT$1,695.721
DC$1,846.581
DE$1,558.931
FL$1,519.10–$1,657.983
GA$1,420.55–$1,604.032
GU$1,774.341
HI$1,774.341
IA$1,444.151
ID$1,452.531
IL$1,456.39–$1,628.074
IN$1,463.031
KS$1,429.301
KY$1,412.511
LA$1,407.16–$1,492.172
MA$1,654.55–$1,866.162
MD$1,595.05–$1,846.583
ME$1,454.47–$1,559.432
MI$1,450.74–$1,534.782
MN$1,611.181
MO$1,373.41–$1,506.673
MS$1,368.871
MT$1,577.501
NC$1,473.891
ND$1,569.791
NE$1,455.721
NH$1,636.441
NJ$1,718.15–$1,820.212
NM$1,457.581
NV$1,576.831
NY$1,499.82–$1,873.405
OH$1,449.161
OK$1,416.621
OR$1,567.75–$1,739.502
PA$1,455.72–$1,642.162
PR$1,593.571
RI$1,626.521
SC$1,463.341
SD$1,568.881
TN$1,437.121
TX$1,443.70–$1,661.868
UT$1,487.601
VA$1,548.59–$1,846.582
VI$1,593.571
VT$1,556.321
WA$1,653.82–$1,914.732
WI$1,506.491
WV$1,389.701
WY$1,574.141

See 31295 in every payment locality

How the 31295 rate is calculated

Each of 31295’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 31295

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.63

2.63 RVUs× 1.000 GPCI

Practice expense44.21

44.21 RVUs× 1.000 GPCI

Malpractice0.39

0.39 RVUs× 1.000 GPCI

Adjusted RVUs

47.2300

Conversion factor

$33.4009

Medicare rate

$1,577.52

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Rhode Island inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

3,550

Code
31295
Physician work
2.63
Practice expense
44.21
Malpractice
0.39

GPCI2026.csv

92

Locality
Rhode Island
Physician work
1.019
Practice expense
1.033
Malpractice
0.892
Office calculation for 31295 in Rhode Island
ComponentRVULocality factorAdjusted
Physician work2.63× 1.0192.6800
Practice expense44.21× 1.03345.6689
Malpractice0.39× 0.8920.3479
Total RVUs48.6968
Conversion factor× 33.4009

Office rate, Rhode Island$1626.52

Office: (2.63 × 1.019 + 44.21 × 1.033 + 0.39 × 0.892) × $33.4009 = $1626.52

Facility: (2.63 × 1.019 + 1.02 × 1.033 + 0.39 × 0.892) × $33.4009 = $136.33

Open 31295 in the RVU calculator

Payment rules and modifiers for 31295

The CMS indicators that decide how 31295 is paid alongside other services.

CMS payment indicators · 31295

Sinus dilation, maxillary sinus ostium

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures3Endoscopy family rules apply.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

31295 without 50 · national office

$1,577.52

Sinus dilation, maxillary sinus ostium

31295-50 · Bilateral: 150%

$2,366.28

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

Codes related to 31295

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 31295
CodeHow it relatesOffice range, Rhode Island
Same family
31296Sinus dilation, frontal sinusBalloon dilation in the same endoscopic sinus series, for the frontal sinus.$1,652.71
31297Sinus dilation, sphenoid ostiumBalloon dilation in the same endoscopic sinus series, for the sphenoid sinus.$1,613.32
31298Sinus dilation, frontal and sphenoidCombines frontal and sphenoid sinus balloon dilation in the same procedure family.$3,058.56
Used instead
31256Maxillary antrostomy, without tissue removalConventional endoscopic maxillary sinus surgery rather than balloon ostium dilation.No office rate
31267Sinus endoscopy, maxillary tissue removalMaxillary sinus endoscopy with tissue removal, rather than balloon dilation alone.No office rate

How 31295 has changed in Rhode Island

31295 · Office / nonfacility

$1626.52

Effective 2026-10-01

The base rate is $48.88 higher than on 2025-10-01, moving from $1577.64 to $1626.52 (3.1%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $1577.64changed to$1626.52

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.70 changed to 2.63
    • Practice expense RVU 43.96 changed to 44.21
    • Work GPCI 1.025 changed to 1.019
    • Practice expense GPCI 1.039 changed to 1.033
    • Malpractice GPCI 0.849 changed to 0.892

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $1701.00changed to$1577.64

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 46.20 changed to 43.96

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $1673.24changed to$1701.00

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $1793.32changed to$1673.24

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 47.72 changed to 46.20
    • Malpractice RVU 0.37 changed to 0.39
    • Work GPCI 1.023 changed to 1.025
    • Practice expense GPCI 1.044 changed to 1.039
    • Malpractice GPCI 0.915 changed to 0.849

  5. January 1, 2023

    RVU23A

    $1877.03changed to$1793.32

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 48.76 changed to 47.72
    • Malpractice RVU 0.39 changed to 0.37
    • Work GPCI 1.021 changed to 1.023
    • Practice expense GPCI 1.048 changed to 1.044
    • Malpractice GPCI 0.981 changed to 0.915

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $2021.36changed to$1877.03

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 52.30 changed to 48.76
    • Malpractice RVU 0.37 changed to 0.39

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $2023.69changed to$2021.36

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 50.47 changed to 52.30
    • Work GPCI 1.024 changed to 1.021
    • Practice expense GPCI 1.049 changed to 1.048
    • Malpractice GPCI 0.990 changed to 0.981

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $2102.14changed to$2023.69

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 52.54 changed to 50.47
    • Malpractice RVU 0.39 changed to 0.37
    • Work GPCI 1.027 changed to 1.024
    • Practice expense GPCI 1.050 changed to 1.049
    • Malpractice GPCI 0.999 changed to 0.990

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $2154.29changed to$2102.14

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 53.99 changed to 52.54
    • Malpractice RVU 0.38 changed to 0.39

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $2158.70changed to$2154.29

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 54.22 changed to 53.99
    • Malpractice RVU 0.39 changed to 0.38
    • Work GPCI 1.025 changed to 1.027
    • Practice expense GPCI 1.052 changed to 1.050
    • Malpractice GPCI 0.879 changed to 0.999

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $2193.56changed to$2158.70

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 55.28 changed to 54.22
    • Work GPCI 1.022 changed to 1.025
    • Practice expense GPCI 1.053 changed to 1.052
    • Malpractice GPCI 0.759 changed to 0.879

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $2201.37changed to$2193.56

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 55.27 changed to 55.28
    • Malpractice RVU 0.40 changed to 0.39

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $2190.42changed to$2201.37

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $2211.62changed to$2190.42

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 55.71 changed to 55.27
    • Malpractice RVU 0.33 changed to 0.40
    • Work GPCI 1.020 changed to 1.022
    • Malpractice GPCI 0.973 changed to 0.759

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    No ratechanged to$2211.62

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$1,626.52$136.33RVU26D
2026-07-01$1,626.52$136.33RVU26C
2026-04-01$1,626.52$136.33RVU26B
2026-01-01$1,626.52$136.33RVU26A
2025-10-01$1,577.64$155.68RVU25D
2025-07-01$1,577.64$155.68RVU25C
2025-04-01$1,577.64$155.68RVU25B
2025-01-01$1,577.64$155.68RVU25A
2024-10-01$1,701.00$159.17RVU24D
2024-07-01$1,701.00$159.17RVU24C
2024-04-01$1,701.00$159.17RVU24B
2024-03-09$1,701.00$159.17RVU24AR
2024-01-01$1,673.24$156.58RVU24A
2023-10-01$1,793.32$162.39RVU23D
2023-07-01$1,793.32$162.39RVU23C
2023-04-01$1,793.32$162.39RVU23B
2023-01-01$1,793.32$162.39RVU23A
2022-10-01$1,877.03$164.85RVU22D
2022-07-01$1,877.03$164.85RVU22C
2022-04-01$1,877.03$164.85RVU22B
2022-01-01$1,877.03$164.85RVU22A
2021-10-01$2,021.36$163.71RVU21D
2021-07-01$2,021.36$163.71RVU21C
2021-04-01$2,021.36$163.71RVU21B
2021-01-01$2,021.36$163.71RVU21A
2020-10-01$2,023.69$167.89RVU20D
2020-07-01$2,023.69$167.89RVU20C
2020-04-01$2,023.69$167.89RVU20B
2020-01-01$2,023.69$167.89RVU20A
2019-10-01$2,102.14$169.22RVU19D
2019-07-01$2,102.14$169.22RVU19C
2019-04-01$2,102.14$169.22RVU19B
2019-01-01$2,102.14$169.22RVU19A
2018-10-01$2,154.29$167.92RVU18D
2018-07-01$2,154.29$167.92RVU18C
2018-04-01$2,154.29$167.92RVU18B
2018-01-01$2,154.29$167.92RVU18AR1
2017-10-01$2,158.70$172.03RVU17D
2017-07-01$2,158.70$172.03RVU17C
2017-04-01$2,158.70$172.03RVU17B
2017-01-01$2,158.70$172.03RVU17A
2016-10-01$2,193.56$171.60RVU16D
2016-07-01$2,193.56$171.60RVU16C
2016-04-01$2,193.56$171.60RVU16B
2016-01-01$2,193.56$171.60RVU16A
2015-10-01$2,201.37$175.15RVU15D
2015-07-01$2,201.37$175.15RVU15C
2015-04-01$2,190.42$174.27RVU15B
2015-01-01$2,190.42$174.27RVU15A
2014-10-01$2,211.62$176.93RVU14D
2014-07-01$2,211.62$176.93RVU14C
2014-04-01$2,211.62$176.93RVU14B
2014-01-01$2,211.62$176.93RVU14A
2013-10-01Rate data unavailableRate data unavailableRVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 31295 for an earlier date of service

Where the Rhode Island rate applies

Rhode Island is a Medicare payment area, not a city. Our Census mapping connects it to 36 cities and communities in Rhode Island. Some span more than one payment area; confirm with the service ZIP.

  • Ashaway
  • Bradford
  • Carolina
  • Central Falls
  • Charlestown
  • Chepachet
  • Clayville
  • Cranston

Browse all communities in Rhode Island

31295 billing questions

How does this differ from 31256?

31295 describes balloon dilation of the maxillary sinus opening. Code 31256 is used for a conventional endoscopic maxillary sinus exploration and opening rather than balloon dilation.

When would 31267 be a better fit?

Use 31267 when the maxillary sinus procedure includes removal of tissue. Balloon dilation of the ostium without that tissue removal is the distinguishing service for 31295.

How is bilateral treatment reported?

CMS identifies this as a bilateral procedure: report modifier 50 for bilateral treatment. CMS pays the bilateral service at 150%.

What happens when another sinus endoscopy is performed during the same session?

CMS endoscopy family pricing applies when related endoscopies are performed together. The operative report should identify each sinus procedure performed.

Is same-day postoperative care separately included in the global period?

No. The 0-day global period includes same-day preoperative and postoperative care.

Can an assistant surgeon be reported?

CMS may pay for an assistant at surgery. Co-surgeons and team surgery are not permitted for this service.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 31295PPRRVU2026_Oct_nonQPP.csv, line 3,550 (RVU26D)
Geographic factors for Rhode IslandGPCI2026.csv, line 92 (RVU26D)

Open CMS sourceHow we calculate rates

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